U.S. Supreme Court upholds Obama law's requirement that most Americans have health insurance (read the ruling)

WASHINGTON -- In a momentous ruling touching virtually every American, the Supreme Court narrowly upheld President Barack Obama's historic health care overhaul Thursday with the unlikely help of conservative Chief Justice John Roberts.

The decision also gave Republicans ammunition to energize supporters in the battle for the White House and to fight what they dubbed "Obamacare" as a new tax on people who don't obtain health insurance.

Roberts' vote, along with those of the court's four liberal justices, preserved the largest expansion of the nation's social safety net in more than 45 years, including the hotly debated requirement that nearly everyone have health insurance or pay a penalty. The aim is to extend coverage to more than 30 million people who now are uninsured.

The 5-4 decision means the huge health care overhaul, still taking effect, can proceed and pick up momentum over the next several years, with an impact on the way countless Americans receive and pay for their medical care.

The ruling handed Obama a victory by rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they would try to use the decision against him.

At the White House, Obama declared, "Whatever the politics, today's decision was a victory for people all over this country."

Blocks away, GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it "bad law" and promising to work to repeal it if he is elected in November.

Demonstrators for and against the law crowded the grounds outside the Supreme Court on Capitol Hill as Roberts, sitting at the center of the nine black-robed justices inside, announced the decision to a packed courtroom.

Roberts, who broke with the other conservative justices, read the judgment that allows the law to go forward. He explained at length the court's view of the "insurance mandate" as a valid exercise of Congress' authority to "lay and collect taxes." The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.

Congress called the payment a penalty, not a tax, but Roberts said the court would not get hung up on labels. Among other indications it is a tax, Roberts said, "the payment is collected solely by the IRS through the normal means of taxation."

"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts said.

Many Republicans oppose the law, claiming that it is a government takeover of health care, curtails Medicare spending and raises taxes.

They also cite predictions private employers will be forced to reduce or eliminate coverage and that the legislation will wind up costing far more than estimated, raising federal deficits as a result.

The court found problems with the law's expansion of Medicaid, but even there it said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part.

The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding."

The justices rejected two of the administration's three arguments in support of the insurance requirement. Roberts agreed with his conservative colleagues that Congress lacks the power under the Constitution's commerce clause to put the mandate in place.

"The federal government does not have the power to order people to buy health insurance," he said in a part of his opinion that the liberal justices did not join. But his bottom line was: "The federal government does have the power to impose a tax on those without health insurance."

The legislation passed Congress in early 2010 after a monumental struggle. Every Republican in Congress voted against it.

House Majority Leader Eric Cantor, R-Va., said Thursday the House will vote July 11 on whether to repeal the Affordable Care Act, though such efforts have no chance in the Democratic-controlled Senate.

House Speaker John Boehner, R-Ohio, said the health care law makes it harder for small businesses to hire workers. "Today's ruling underscores the urgency of repealing this harmful law in its entirety," he said.

Senate Majority Leader Harry Reid, D-Nev., heaped praise on the court's decision, and the 2010 law, in a Senate speech.

"Passing the Affordable Care Act was the greatest single step in generations toward ensuring access to affordable, quality health care for every American, regardless of where they live or how much money they make," he said.

After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against "Obamacare" -- the name the GOP gave the plan in derision, though some Democrats accept it -- and in attacking the president's signature health care reform package as a tax increase.

Democrats said Romney, who backed a similar individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling.

"Mitt Romney is the intellectual godfather of 'Obamacare,'" said Democratic consultant Jim Manley. "The bigger issue is the rising cost of health care, and this bill is designed to deal with it."

More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices.